Provider Demographics
NPI:1295727394
Name:VELDMAN, STEPHANIE J (DC,CCSP)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:J
Last Name:VELDMAN
Suffix:
Gender:F
Credentials:DC,CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 18TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1061
Mailing Address - Country:US
Mailing Address - Phone:712-336-1330
Mailing Address - Fax:712-336-4240
Practice Address - Street 1:2007 18TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1061
Practice Address - Country:US
Practice Address - Phone:712-336-1330
Practice Address - Fax:712-336-4240
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5663111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1090308Medicaid
IAI12945Medicare ID - Type UnspecifiedPROVIDER NUMBER